Evaluating The Sustainability Of Stainless Steel Crowns And Zirconia Crowns In Pediatric Patients
DOI:
https://doi.org/10.64252/6q8rce17Keywords:
Pediatric Dentistry, Stainless Steel Crown, Zirconia Crown, Sustainability, Life Cycle Assessment, Cost-Effectiveness, Patient-Reported Outcomes.Abstract
Background: Stainless steel crowns (SSCs) and zirconia crowns are the primary choices for full-coverage restorations of severely decayed primary molars. While clinical efficacy is well-documented, a comprehensive sustainability assessment, encompassing environmental, economic, and social factors, is lacking.
Methods: This prospective, comparative clinical study involved 120 children (aged 4-7 years) requiring a full-coverage restoration on a primary molar. Patients were randomly allocated to receive either an SSC (n=60) or a zirconia crown (n=60). Clinical performance (Gingival Index, Plaque Index, survival rate) was evaluated at 6, 12, and 24 months. A cradle-to-grave LCA was performed to quantify environmental impact, focusing on Global Warming Potential (GWP). Economic analysis included material costs, chair-side time, and re-treatment needs. Parental satisfaction with aesthetics and overall experience was measured using a 10-point Visual Analog Scale (VAS) at 12 months. Data were analyzed using independent t-tests and Chi-square tests (α = 0.05).
Results: At 24 months, both crown types demonstrated high survival rates (SSC: 96.7%, Zirconia: 95.0%; p=0.654). Zirconia crowns showed significantly better gingival health (Gingival Index: 0.45 ± 0.18 vs. SSC: 0.88 ± 0.24; p<0.001). The LCA revealed a significantly higher environmental impact for zirconia crowns (GWP: 1.32 ± 0.11 kg CO₂-eq vs. SSC: 0.79 ± 0.09 kg CO₂-eq; p<0.001). The total cost per restoration was substantially lower for SSCs ($142.50 ± $15.80 vs. Zirconia: $295.70 ± $28.40; p<0.001). Parental satisfaction with aesthetics was overwhelmingly higher for zirconia crowns (VAS score: 9.3 ± 0.6 vs. SSC: 3.8 ± 1.2; p<0.001).
Conclusion: A significant trade-off exists in the sustainability of pediatric crowns. SSCs exhibit superior environmental and economic sustainability, making them a pragmatic choice for public health applications. In contrast, zirconia crowns offer distinct advantages in biocompatibility and aesthetics, aligning with patient-centered social sustainability goals. The selection of crown material requires a balanced consideration of these competing factors to achieve truly sustainable pediatric dental care.
